高胸段硬膜外阻滞对猪急性心肌缺血/再灌注损伤的保护作用

目的：探讨高胸段硬膜外阻滞（HTEA）对心肌缺血／再灌注损伤的保护作用。方法：20只家猪随机分为两组，结扎左冠状动脉前降支（LAD）造成造血40min后再灌注6h，实验组（n=10)结扎前硬膜外腔注入0．5％布比卡因2ml;对照组（n=10)结扎前硬膜外腔注入生理盐水2ml。测定心率（HR）、平均动脉压（MAP）、中心静脉压（CVP）、血浆超氧化物歧化酶（SOD）活性、血清丙二醛（MDA）浓度、心肌乳酸（LA）释放量。结果：（1）实验组硬膜外阻滞的HR减慢22％，MAP、CVP分别降低25％和28％，而对照组血液动力学无明显变化。（2）实验组SOD活性变化不显著，再灌注5h、6h活性升高（P＜0．01）；MDA浓度在4h降至最低点（P＜0．05）；对照组SOD活性明显降低（P＜0．05），MDA含量明显增加（P＜0．05）。（3）两组心肌LA释放量在开放前达到高峰，之后随着供血、供氧的恢复逐渐下降，但实验组明显低于对照组（P＜0．01）。（4）开始再灌注时由于发生室颤实验组死亡1只，对照组死亡只（P＜0．05）。结论：HTEA可以减轻心肌缺血／再灌注损伤，其机制与保护SOD活性，降低心肌氧耗及脂质过氧化程度有关。     

卡维地洛治疗慢性充血性心力衰竭及其抗氧化作用的临床研究

目的研究卡维地洛治疗慢性充血性心力衰竭的效果及其抗氧化作用。方法选取120例慢性充血性心力衰竭患者,随机分为治疗组（60例）和对照组（60例）,治疗组在常规治疗的基础上加用卡维地洛,对照组在常规治疗的基础上加用美托洛尔,两组均治疗3个月,治疗前后分别进行心脏超声检查评价心功能并测定血清丙二醛（MDA）和超氧化物歧化酶（SOD）水平。结果治疗前两组患者心功能及血清MDA、SOD水平比较差异无统计学意义,治疗后两组患者心功能均较治疗前改善（P＜0．05）;治疗组治疗后血清MDA水平[（6．2±1．7）mmol／L]较治疗前[（9．7±2．4）mmol／L]明显降低（P＜0．05）,血清SOD水平较治疗前显著升高[分别为（118．2-I-24．6）U／ml和（84．5±19．4）U／ml]（P＜0．01）,而对照组血清MDA、SOD水平治疗前后无明显变化。结论卡维地洛可改善慢性充血性心力衰竭患者心功能状况,并且具有抗氧化作用。     

急性胰腺炎合并肝损伤时IL-6、氧自由基变化及IL-2、川芎嗪干预的实验研究

目的：探讨IL－6、氧自由基在急性胰腺炎（acute pancreatitis，AP）合并肝损伤中的作用，及重组人白介素－2（IL－2）、川芎嗪的治疗价值。方法：SD大鼠112只，随机分为14只，每组8只，5％牛磺胆酸钠逆行胰胆管内注射诱发大鼠AP动物模型，检测血浆IL－6、SOD、MDA、ALT、AST、LDH、LIP、AMY，并观察肝、胰病理变化。结果；①AP组血浆AMY、LIP、ALT、AST、LDH明显升高（P＜0．05或0．01），镜下可见胰腺水肿、炎细胞浸润、坏死1肝脏肝窦充血、细胞浊肝及坏死，且损伤程度随时限延长而加重；②AP各组血浆IL－6明显升同（P＜0．01）；③AP各组MDA明显高（P＜0．01）、SOD明显降低（P＜0．01）。④IL－2治疗组、川芎嗪治疗组有IL－2、川芎嗪联合且与NS组比较血浆IL－6、MDA水平明显下降（P＜0．05），SOD明显升高（P＜0．05），胰、肝病理损害程度减轻，并且AMY、LIP、ALT、AST、LDH均明显降低（P＜0．05），平均存活时间明显延长（P＜0．05）；联合应用组降低IL－6、MDSA水平和减轻胰腺坏死优于单药组。结论：①IL－6、氧自由基在急性胰腺炎合并肝损伤程度和明显升同，起损伤作用，而SOD明显降低，其保护作用减弱。检测血浆IL－6、MDA、SOD可作为判断AP合并肝脏损伤程度和预后的指标；②大鼠急性胰腺合并肝损伤过程中应用IL－2、川芎嗪显示出良好的效果，联合应用于亿于这两药的单独应用。     

益肾排石中药保护高能冲击波致肾损伤的实验研究

目的：探讨益肾排石中药对高能冲击波致肾损伤的保护作用。方法：将家兔30只随机分为两组，中药组和生理盐水对照组各15只，于高能冲击波致兔肾损伤模型，测定不同时间血浆，肾组织浆浆内皮素（ET－1），超氧化物歧化酶（SOD）、丙二醛（MDA）变化及肾组织病理改变。结果：冲击波肾损伤后血浆中ET－1、血清中MDA值及组织均浆中ET－1、MDA值显著升高（P＜0．05），血浆及组织匀浆中SOD显著降低（P＜0．05）；而中药治疗组血浆中ET－1、MDA及组织均浆中ET－1、MDA峰值显著低于对照组（P＜0．05），血浆及组织匀浆中SOD值高于对照组（P＜0．05），且病理检查较对照组损伤轻。结论：益肾排石中药对高能冲击波致肾损伤具有保护作用。     

血液灌流抢救重度急性有机磷中毒的疗效观察

目的：探讨血液灌流（HP）抢救重度急性有机磷农药中毒（AOPP）的疗效及影响因素。方法：将64例重度AOPP病人随机分为观察组和对照组各32例，观察组在常规治疗基础上行血流灌流治疗，对照组按常规治疗，观察两组病人的治疗效果。结果：观察组清醒时间和达阿托品化的时间缩短，血清胆碱脂酶（ChE)恢复活力时间明显较对照组缩短（P＜0．05）；阿托品用量较对照组减少1／3（P＜0．05）；观察组痊愈27例，自动出院5例，痊愈率与对照组比较，差异有显著性意义（P＜0．05）。结论：重度AOPP病人在常规治疗的同时，早期给予HP治疗可提高抢救成功率。     

缬沙坦治疗心力衰竭疗效观察

目的；观察缬沙坦治疗充血性心力衰竭（CHF）的临床疗效。方法：70例经常规洋地黄，利尿剂，扩张血管药等治疗效果不佳的CHF患者，给予口服缬沙坦80－160mg/d，治疗3－5周。观察治疗前后心率，心胸比，血压，左室舒张末期内径，左室射血分数以及心脏功能的变化。结果：治疗后心率，血压，心胸比及左室舒张末期内径均明显下降（P＜0．05）。左室射血分数增加（P＜0．01），心功能改善1－2级。药物副作用少，患者易耐受。结论：缬沙坦治疗CHF疗效好，副作用少，便于临床推广。     

复方丹参对心内直视手术心肌缺血再灌注后血清过氧化脂质及前列环素变化的影响

目的：观察复方丹参对心肺转流（CPB）心内直视手术心肌缺血再灌注后血清过氧化脂质及前列环素（PGI2）变化的影响。方法：20例先天性室间隔缺损或房间隔缺损患者麻醉后随机分为对照组（I组，n=10）及丹参组（Ⅱ组，n=10）。Ⅱ组患者于手术开始前及复温后心脏复跳前分别静注复方丹参200mg/kg，I组给予等容量复方乳酸钠。于手术开始前（T0）、心肌缺血前（T1）、心肌缺血30分钟（T2）、再灌注后10分钟（T3）和30分钟（T4）、停CPB30分钟（T5）及再灌注后24小时（T6）抽中心静脉血测丙二醛（MDA）及前列环素。结果：I组血清MDA于CPB后逐渐升高，再灌注后迅速增加，于T4、T5、T6显著高于其T2时值（P＜0．05或P＜0．01）。Ⅱ组再灌注后未出现显著的血清MDA升高，且缺血及再灌注后各时期Ⅱ组MDA均显著低于I组（P＜0．05）。CPB后再组前列环素均显著上升，而再灌注后迅速下降，但T2及T6时Ⅱ组前列环素均显著低于I组（P＜0．01，P＜0．05）。术后Ⅱ组心功能的恢复优于I组。结论：复方丹参能显著降低心脏缺血及再灌注期脂质过氧化程度，抑制缺血期前列环素的急剧增加，促进术后心肌功能的恢复。     

骨关节病患者病情程度与体内自由基含量变化分析

目的：探讨骨关节病（OA）患者病情程度与其血清和关节液中的自由基含量的关系。方法：对轻度、中度和重度45例膝OA患者及26例健康对照者血清和关节液中一氧化氮（NO）、超氧化物歧化酶（SOD）和丙二醛（MDA）的含量进行了测定。结果：与健康组比较，OA患者血清中NO和MDA含量显著升高（P＜0．01），SOD含量明显下降（P＜0．05），且有依病情的加重而含量变化更加明显的趋势（P＜0．05），关节中NO、MDA和SOD含量的变化较血清中更为显著。结论：OA患者体内自由基水平增高，与病情程度正相关，自由基直接和自由基相互反应毒性产物间接损伤关节软骨，是OA病程发展的重要机制。     

乳腺癌病人围手术期红细胞补受体Ⅰ活性及丙二醛水平的变化

目的 了解乳腺癌病人围手术期红细胞免疫状态及丙二醛（MDA）的变化。方法 30例病人随机分成静吸复合全麻（A组）和高位硬膜外阻滞（B）组,分别于麻醉前、麻醉后、手术中和术后1天、3天及5天取静脉血测定红细胞补体受体Ⅰ活性（CR－I）和MDA水平。结果 A组麻醉后、术中、术后1天及3天RBC－C3bRR、RBC－CaR及PEER均比麻醉前明显下降（P＜0．05或P＜0．01）,B组仅在术中及术后1天明显下降（P＜0．05）。两组在各同一时点相比,A组麻醉后较B组低（P＜0．05）。RFIR和MDA在A组麻醉后、术中、术后1天及3天均明显高于麻醉前（P＜0．05或P＜0．01）,B组也在术中及术后1天明显高于麻醉前（P＜0．05）。两组病人术后5天CR－Ⅰ和MDA均恢复到麻醉前水平。结论 乳腺癌病人围手术期红细胞免疫功能受到明显抑制,静吸复合全麻影响大于高位硬膜外阻滞,并且与红细胞免疫调节功能紊乱及血浆MDA水平有关。     

血管紧张素转化酶抑制剂对心衰大鼠心肌收缩特性及钙调控蛋白表达的影响

目的观察血管紧张素转化酶抑制剂（ACEI）对心衰大鼠心肌收缩特性的影响，探讨与心肌细胞钙调控蛋白NCX1、SERCA2、PLB表达水平的关系。方法缩窄Wistar大鼠腹主动脉制作心衰模型，随机分成培哚普利治疗组（CHF-T，n＝16）、心衰对照组（CHF-C，n＝16）和假手术组（PS，n＝10）。12周后，进行心肌收缩功能测定和心肌钙调控蛋白的免疫荧光半定量分析。结果CHF-C组的左室舒张未期压力（LVEDP）高于PS组、＋dp／dt和-dp／dt则较PS组为低（P均〈0．05），ACE抑制剂治疗的CHF-T组则明显减轻上述改变（尸均〈0．05）；在1．0Hz电刺激下，CHF-T组心肌细胞缩短分数Fs（％）与CHF-C组比较，有明显改善（10．89±1．18、7．51±1．15，P〈0．01）。NCX1、SERCA2的蛋白表达量在CHF-T、CHF．C和PS3组间差异有统计学意义（NCX1：2988．79±149．37、3289．03±153．63、2780．61±136．57（P〈0．01）；SERCA2：4380．82±237．15、4092．05±185．76、4703．81±250．35，P〈0．01），其中CHF-C组与PS组比较，NCX1表达明显增高、SERCA2明显降低（P〈0．01）；CHF—T组与CHF—C组比较，其NCX1表达显著降低（P〈0．01）、SERCA2有所增高（P〈0．05），但均未恢复至假手术组水平（P〈0．05）。而PLB在各组间的表达差异无统计学意义（P〉0．05）。结论ACEI的长程干预可以减缓心力衰竭时心肌钙调控蛋白的变化，保护心肌的收缩特性。     

High thoracic epidural analgesia improves left ventricular function in patients with ischemic heart

Background: In patients with ischemic heart disease, high thoracic epidural analgesia (HTEA) has been proposed to improve myocardial function. Tissue Doppler Imaging (TDI) is a tool for quantitative determination of myocardial systolic and diastolic velocities and a derivative of TDI is tissue tracking (TT), which allows quantitative assessment of myocardial systolic longitudinal displacement during systole. The purpose of this study was to evaluate the effect of thoracic epidural analgesia on left ventricular (LV) systolic and diastolic function by means of two-dimensional (2D) echocardiography and TDI in patients with ischemic heart disease.
Methods: The effect of a high epidural block (at least Th1–Th5) on myocardial function in patients (N=15) with ischemic heart disease was evaluated. Simpson's 2D volumetric method was used to quantify LV volume and ejection fraction. Systolic longitudinal displacement was assessed by the TT score index and the diastolic function was evaluated from changes in early ( E ") and atrial ( A ") peak velocities during diastole.
Results: After HTEA, 2D measures of left ventricle function improved significantly together with the mean TT score index [from 5.87 ± 1.53 to 6.86 ± 1.38 ( P <0.0003)], reflecting an increase in LV global systolic function and longitudinal systolic displacement. The E "/ A " ratio increased from 0.75 ± 0.27 to 1.09 ± 0.32 ( P =0.0026), indicating improved relaxation.
Conclusion: A 2D-echocardiography in combination with TDI indicates both improved systolic and diastolic function after HTEA in patients with ischemic heart disease.     

Hemodynamic evaluation of heterotopic heart transplantation.

To assess the relative contribution of native and donor hearts to total circulatory performance after heterotopic transplantation, we used cardiac catheterization to examine 10 patients. Left and right ventricular filling pressures significantly decreased by 41% and 36%, respectively, cardiac index increased by 25%, and pulmonary arteriolar resistance was reduced by 61%. Patients were subdivided into two groups according to the presence of one (group I) or two (group II) peaks on the aortic pressure curve. In group I, the donor left ventricle assumed total left ventricular work and 80% of right ventricular work. Because the native left ventricle could not generate enough pressure to open the aortic valve, its entire stroke volume was ejected into the common left atrium. In addition, in all four patients a native aortic regurgitation occurred in diastole and systole. In contrast, in group II, native left ventricular systolic pressure always exceeded aortic diastolic pressure. The donor left ventricle contributed 68% to systemic blood flow and the donor right ventricle 51% to pulmonary blood flow. Mild native aortic regurgitation was demonstrated in two patients only. Native left ventricular function deteriorated postoperatively in all patients (ejection fraction decreased from 0.22 +/- 0.09 to 0.14 +/- 0.08), but this deterioration was more marked in group I. Postoperative depression of native left ventricular function could not be ascribed to progression of coronary artery disease but was mainly due to reduced preload (competitive filling) and increased afterload. Thus in group I patients with more severe preoperative left ventricular dysfunction, the donor heart behaved like a total biventricular assist device. In contrast, in group II patients the donor heart acted like a partial biventricular assist device.     

奥美沙坦酯对慢性心力衰竭小鼠肾脏氧化应激的作用

目的 探讨奥美沙坦酯对慢性心力衰竭小鼠肾脏氧化应激的作用。 方法 健康C57小鼠分为假手术组（SHAM组）、慢性心力衰竭组（CHF组）和奥美沙坦酯治疗组（OLM组）。以冠状动脉左前降支结扎法建立慢性心力衰竭小鼠模型，其中奥美沙坦酯治疗组以10 mg/kg剂量每日胃饲，12周时观察各组小鼠心率、血压、心功能状况、Scr、BUN、血浆和肾脏血管紧张素（Ang）Ⅱ水平。实时PCR法检测肾脏gp91phox、p22phox和NOX4的表达。AZAN染色和二氢乙啶（DHE）染色观察肾组织病理变化。 结果 与SHAM组比较，CHF组和OLM组左室舒张末期内径（LVDd）和左室收缩末期内径（LVDs）显著增加（P ＜ 0.05）；短轴缩短率（FS）和射血分数（EF）显著降低（P ＜ 0.05）；CHF组收缩压、Scr和BUN显著增高，而OLM组以上指标较CHF组均显著降低（P ＜ 0.05）。与SHAM组比较，CHF组血浆和肾脏AngⅡ水平增高，gp91phox、p22phox和NOX4表达增高（P ＜ 0.05）；OLM组肾脏AngⅡ水平、gp91phox、p22phox和NOX4表达较CHF组均显著降低（P ＜ 0.05）。与SHAM组比较，CHF组肾脏AZAN染色和DHE染色阳性增强（P ＜ 0.05），而OLM组较CHF组显著降低（P ＜ 0.05）。 结论 慢性心力衰竭可使肾内NADPH氧化酶激活并导致肾小球间质纤维化，奥美沙坦酯通过抑制AngⅡ引起的氧化应激反应起到肾脏保护作用。     

浅低温体外循环心脏跳动中施术对心肌保护的实验研究

目的　探讨浅低温体外循环（CPB）心脏跳动中心内直视手术对心肌保护的效果。方法　16只健康山羊随机均分为实验组（浅低温心跳组）和对照组（中度低温心停组）。分别在转机后即刻、CPB120、130、150min，取冠状静脉窦血，测定血清中丙二醛（MDA）、超氧化物歧化酶（SOD）、肌酸激酶同工酶（CK-MB）、乳酸脱氢酶（LDH）的含量，并取左室心肌组织观察心肌超微结构的改变。结果　对照组再灌注后MDA、CK-MB、LDH明显升高，SOD明显降低，与实验组相同时点相比，差异有显著意义（P＜0.01）。心肌细胞超微结构观察见对照组变化明显，实验组基本不变。结论　浅低温体外循环心脏跳动中行心内直视手术避免了心肌缺血再灌注损伤过程，有很好的心肌保护效果。     

参脉注射液对心脏瓣膜置换术的心肌保护作用

目的探讨参脉注射液(SMI)在心脏瓣膜置换术中对心肌缺血-再灌注损伤的保护作用。方法将40例心脏瓣膜置换术患者随机均分为参脉组(SM组)和对照组(C组),SM组在心肺转流(CPB)前静脉给予SMI,C组用等量生理盐水。分别于术前、术中、术后多时点采血,比较两组心肌磷酸激酶(CK)、磷酸激酶同工酶(CK-MB)、肌钙蛋白I(cTnI)、丙二醛(MDA)、超氧化物歧化酶(SOD)水平;记录两组患者的手术时间、主动脉阻断时间及术中、术后各时点血管活性药物的用量,观察主动脉开放后心脏自动复跳率、室性心律失常发生率。结果SM组血清CK、CK-MB、cTnI、MDA等指标均低于C组(P<0.05),而两组SOD活性均降低,但SM组明显高于C组(P<0.05)。SM组室性心律失常发生率、除颤次数及血管活性药物的用量明显低于C组(P<0.01)。结论SMI对心脏瓣膜置换术患者心肌缺血-再灌注损伤具有明显保护作用。     

Severe congestive heart failure

Surgical interventions for severe heart failure refractory to medical treatment include the implantation of an artificial heart, tissue engineering, and a myocardial substitute, in addition to conventional coronary revascularization and reduction mitral annuloplasty (RMAP) for functional mitral regurgitation (FMR). Remarkable progress has been made in these surgical methods, but they have not necessarily reached a satisfactory level for clinical application. Cardiac transplantation, the final treatment option for refractory heart failure, has not become a standard procedure, especially in Japan, due to a shortage of donors. However, surgical methods to restore native heart function, such as left ventriculoplasty (LVP). are often effective for those with extremely low cardiac function. Although the long-term prognosis after these procedures has not been determined, they are considered to be an important treatment option, at least as an alternative or biologic bridge to transplantation or artificial heart implantation. LVP is a surgical method to reduce wall stress and improve systolic cardiac function by reducing the left ventricular cavity and remodeling the spherical ventricle into an elliptical shape. Because tethering of the valve leaflets responsible for FMR cannot be corrected by RMAP alone, it appears necessary to repair the total mitral complex to prevent recurrence of FMR.     

Numerical simulation of cardiovascular dynamics with left heart failure and in-series pulsatile ventricular assist device

This article presents a numerical model for investigations of the human cardiovascular circulation system response, where the function of the impaired left ventricle is augmented by the pumping action of a pulsatile ventricular assist device (VAD) connected in series to the native heart. The numerical model includes a module for detailed heart valve dynamics, which helps to improve the accuracy of simulation in studying the pulsatile type VAD designs. Simulation results show that, for the case with left ventricular (LV) failure, the VAD support successfully compensates the impaired cardiovascular response, and greatly reduces the after-load of the diseased ventricle, thus assisting possible recovery of the ventricle from the diseased condition. The effects of these conditions on pulmonary circulation are also shown. To investigate the effect of different pumping-activation functions (VAD motion profiles) on the cardiovascular response, three different VAD motion profiles are investigated. The numerical results suggest that Hermitian type motion profiles (smooth curves skewed toward early systole) have the advantage of requiring minimum power to the VAD, and producing the minimum after-load to the left ventricle, minimum ventricular wall stress, and minimum ventricular work to the diseased ventricle; while sawtooth type motions need slightly more power input, and induce slightly increased aortic pressure in diastole, thus improving coronary perfusion.     

Modification of myocardial ischemia in normal and hypertrophied hearts utilizing diastolic retroperfusion of the coronary veins

Myocardial infarction following coronary occlusion limits the effectiveness of emergency coronary artery bypass operations. We designed and evaluated a transvenously introduced balloon-tipped catheter and an electrocardiogram-activated pumping system for perfusing ischemic myocardium by retrograde pulsation of oxygenated blood into the coronary veins during diastole. Balloon deflation during systole allowed for normal venous drainage. Four groups of dogs (n = 26) were instrumented with sonomicrometry crystals and catheters to measure regional and global left ventricular function. Two groups of dogs had chronic left ventricular (LVH) produced by prior aortic banding (left ventricular mass 174 gm versus 115 gm for control dogs of equal body weight, p less than or equal to 0.05). The left anterior descending coronary artery (LAD) was occluded for 40 minutes; after 10 minutes left ventricular function was severely depressed in all groups (less than or equal to 0.05 compared to baseline). Groups 1 (normal left ventricle, n = 8) and 2 (LVH, n = 5) had no further therapy for the following 30 minutes. Groups 3 (normal left ventricle, n = 8) and 4 (LVH, n = 5) received 30 minutes of coronary vein retroperfusion (CVRP) 10 minutes following the LAD occlusion. CVRP restored 37% of systolic shortening, whereas there was no restoration of systolic shortening in control dogs (p less than or equal to 0.001). All other physiological and hemodynamic parameters including heart rate, cardiac output, aortic pressure, dP/dt, and left ventricular dilatation were normalized during CVRP while remaining severely depressed in control dogs (p less than or equal to 0.05). Following restoration of arterial flow at 40 minutes, 10 of 13 CVRP-treated dogs recovered normal left ventricular function while only two of 13 untreated dogs survived. CVRP offers a transvenous approach for modifying myocardial ischemia prior to emergency coronary artery bypass grafting.     

Reduction of tricuspid annular doppler tissue velocities in pediatric heart transplant patients.

BACKGROUND: Orthotopic heart transplantation is a life-saving therapy for children with end-stage heart disease. However, 50% of these transplanted children die or require re-transplantation 12 years later. Progressive deterioration of cardiac function is a common feature of long-term survivors; however, quantitative evaluation of the state of the right ventricle has been lacking. Tissue Doppler imaging (TDI) has been used to measure alterations in right ventricular (RV) function in other illnesses. The purpose of this study was to quantitate abnormalities in tricuspid annular systolic and diastolic velocities as an indicator of RV dysfunction, and to evaluate if time since transplantation and the presence of tricuspid regurgitation are associated with quantitative changes in tricuspid annular velocities in pediatric heart transplant recipients. METHODS: TDI was performed and velocities recorded during systole and early and late diastole at the tricuspid annulus, septum and mitral annulus in transplanted patients and in a control group with normal hearts. Pulsed wave Doppler mitral and tricuspid inflows were also measured and the severity of tricuspid regurgitation was estimated using color flow mapping. Patients with biopsy evidence of active cellular rejection or left ventricular ejection fraction of <60% were excluded from study. RESULTS: Thirty-five patients were divided into a normal heart group (n = 14) and a transplant group (n = 21), aged from 1 to 23 years. Systolic and early diastolic velocities at the tricuspid annulus and septum in the transplant group were reduced significantly compared with the normal group (p < 0.05): tricuspid annular systolic, 5.8 +/- 1.4 vs 9.4 +/- 1.7 cm/sec; early diastolic, -6.4 +/- 2.6 vs -9.7 +/- 2.6 cm/sec; septum systolic, 3.9 +/- 1.5 vs 5.8 +/- 1.4 cm/sec; and early diastolic, -6.3 +/- 2.4 vs -9.1 +/- 2.5 cm/sec. Patients were divided into early (<5 years) and late (>5 years) term groups since transplantation. Tissue velocities at the tricuspid annulus in the late term group had further reduction in systole, 4.9 +/- 1.4 vs 6.4 +/- 1.1 cm/sec, and early diastole, -5.3 +/- 1.5 vs -7.1 +/- 2.9 cm/sec (p < 0.05). Patients with severe tricuspid regurgitation had systolic and early diastolic velocities at the tricuspid annulus that were further reduced. Left ventricular mitral inflow Doppler early/late diastolic ratios became significantly different from the normal group 5 years after transplantation (p < 0.05). CONCLUSIONS: TDI demonstrated that tricuspid annular systolic and early diastolic velocities were abnormal in children after transplantation and became significantly more abnormal with prolonged time after transplantation. These alterations were not dependent on the presence of severe tricuspid regurgitation but appeared to be exacerbated by its presence. Evidence of diastolic left ventricular dysfunction was not detected before 5 years after transplantation in this unselected group. A prospective study may be required to define the evolution and progression of right and left ventricular dysfunction in children after heart transplantation.     

The influence of increase in heart rate on coronary flow dynamics in the patients with aortic stenosis]

To clarify the causative factors responsible for the development of effort angina in aortic stenosis, the influence of an increase in heart rate by atrial pacing and isoproterenol infusion on the phasic left coronary flow velocity waveforms were studied using a pulsed Doppler velocimeter during cardiac surgery. Coronary flow velocity waveforms in aortic stenosis was characterized by a slowly increased diastolic inflow and an elongation of the time from the onset of diastole to the diastolic peak velocity. An increase in heart rate by pacing brought about a marked decrease in diastolic coronary flow since the slowly increasing diastolic flow was cut with the onset of following systole. On the contrary, after an increase in heart rate by infusion of isoproterenol, diastolic increasing rate in the coronary flow waveform accelerated and diastolic peak velocity markedly increased. As the results, isoproterenol produced a significant increase in diastolic coronary inflow.